With the establishment of optometry as the primary eye care profession, and significant reforms under way in health care, the opportunity exists now to add value to an independent eye care practice for both the doctor and the patient. The favorable geographic distribution of optometrists in rural and urban locations lends well to the evolving trends of health care in America. Ease of access to care without having to travel long distances lends well to the economics for patients. The difficulty for the independent practice is the paradigm shift required on several levels: from paper records to electronic; from an optical focus to medical, from individual and episodic care to team-based and coordinated care. Add to this the concomitant increase in the complexity of billing and coding and we have a whole new game on our hands, a survival game. The exact strategy to make this shift adeptly does not exist. Vision without execution is hallucination. This guide will serve as a basis for applying some organizational sense to the adventure of creating a new medical model for forward-thinking optometric practices.